Title Page
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Site conducted
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Conducted on
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Prepared by
General/Sales Floor
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5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?
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7. Are extension cords used in place of installed electric outlets or as permanent wiring?
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8. Are extension cords running through ceilings, doors, walls or under carpets?
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9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?
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10. Any frayed electrical wiring (usually where the cord enters the plug)?
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11. Are appliances or equipment missing ground pin on the electrical plug?
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16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?
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17. Are fire suppression sprinkler heads blocked by items?
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18. Do any fire suppression sprinkler heads have decorations attached with tape?
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22. Any broken or missing electrical outlet covers?
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23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?
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24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?
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25. Are Fire Extinguishers inspected monthly and pathway clear of obstruction?
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26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?
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27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?
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28. Do floor mats lay flat on floor, free of trip hazards?
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32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?
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Are eyewash stations inspected weekly?
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34. Any other issues identified?
Front End
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5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?
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7. Are extension cords used in place of installed electric outlets or as permanent wiring?
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8. Are extension cords running through ceilings, doors, walls or under carpets?
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9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?
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10. Any frayed electrical wiring (usually where the cord enters the plug)?
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11. Are appliances or equipment missing ground pin on the electrical plug?
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14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?
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16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?
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17. Are fire suppression sprinkler heads blocked by items?
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18. Do any fire suppression sprinkler heads have decorations attached with tape?
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22. Any broken or missing electrical outlet covers?
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23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?
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24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?
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26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?
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27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?
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28. Do floor mats lay flat on floor, free of trip hazards?
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29. Are shopping carts missing child restraints (Seat belts)?
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30. Do Motorized Handicap Carts have damaged electrical charging cable (cracked, frayed or missing ground pin)?
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31. Any Shopping carts with child seats have missing or broken safety restraint systems?
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32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?
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33. Are cashiers using “sweep motions” … using hand scanners for heavy, bulky items?
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Are eyewash stations inspected weekly?
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34. Any other issues identified?
Grocery Department
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1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?
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3. Are price molding strips bent and protruding out with sharp edges (may cut or scratch patrons or workers)?
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4. Are warehouse storage shelves/racks missing the minimum of two cross member supports?
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5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?
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6. Any ice buildup on freezer doors, entrances, floors or walls?
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7. Are extension cords used in place of installed electric outlets or as permanent wiring?
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8. Are extension cords running through ceilings, doors, walls or under carpets?
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9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?
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10. Any frayed electrical wiring (usually where the cord enters the plug)?
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11. Are appliances or equipment missing ground pin on the electrical plug?
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12. Are compress gas cylinders secured to prevent them from falling?
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13. Are moisture proof globes/covers in freezers either missing or broken?
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14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?
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15. Are trailers using wheel chokes or restraint systems during loading or offloading by forklifts/PIT?
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16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?
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17. Are fire suppression sprinkler heads blocked by items?
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18. Do any fire suppression sprinkler heads have decorations attached with tape?
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19. Are forklifts parked on inclines?
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20. Are forklifts/electric pallet jacks inspected before use?
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21. Do electric roll up/down doors have operative automatic emergency stop?
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22. Any broken or missing electrical outlet covers?
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23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?
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24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?
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26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?
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27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?
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28. Do floor mats lay flat on floor, free of trip hazards?
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32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?
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Are eyewash stations inspected weekly?
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34. Any other issues identified?
Meat Department
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1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?
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2. Are electrical outlets in the meat department missing moisture/water proof cover?
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5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?
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7. Are extension cords used in place of installed electric outlets or as permanent wiring?
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8. Are extension cords running through ceilings, doors, walls or under carpets?
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9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?
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10. Any frayed electrical wiring (usually where the cord enters the plug)?
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11. Are appliances or equipment missing ground pin on the electrical plug?
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14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?
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16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?
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17. Are fire suppression sprinkler heads blocked by items?
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18. Do any fire suppression sprinkler heads have decorations attached with tape?
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22. Any broken or missing electrical outlet covers?
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23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?
-
24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?
-
26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?
-
27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?
-
28. Do floor mats lay flat on floor, free of trip hazards?
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32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?
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Are eyewash stations inspected weekly?
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34. Any other issues identified?
Produce Department
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1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?
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5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?
-
7. Are extension cords used in place of installed electric outlets or as permanent wiring?
-
8. Are extension cords running through ceilings, doors, walls or under carpets?
-
9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?
-
10. Any frayed electrical wiring (usually where the cord enters the plug)?
-
11. Are appliances or equipment missing ground pin on the electrical plug?
-
14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?
-
16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?
-
17. Are fire suppression sprinkler heads blocked by items?
-
18. Do any fire suppression sprinkler heads have decorations attached with tape?
-
22. Any broken or missing electrical outlet covers?
-
23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?
-
24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?
-
26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?
-
27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?
-
28. Do floor mats lay flat on floor, free of trip hazards?
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32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?
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Are eyewash stations inspected weekly?
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34. Any other issues identified?
Deli/Bakery/Sushi
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1. Are mops hung up to dry (mops standing in buckets of water causes bacteria laden water to be used to clean floors)?
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5. Are paths to circuit breaker panels and/or fire extinguishers, alarm pull stations and eyewash stations clear of obstruction (at least three feet)?
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6. Any ice buildup on freezer doors, entrances, floors or walls?
-
7. Are extension cords used in place of installed electric outlets or as permanent wiring?
-
8. Are extension cords running through ceilings, doors, walls or under carpets?
-
9. Are extension cords and/or surge protectors/suppressors plugged together to obtain length?
-
10. Any frayed electrical wiring (usually where the cord enters the plug)?
-
11. Are appliances or equipment missing ground pin on the electrical plug?
-
12. Are compress gas cylinders secured to prevent them from falling?
-
13. Are moisture proof globes/covers in freezers either missing or broken?
-
14. Are fluorescent light covers in coolers and/ or freezers sealed to light assembly (to prevent moisture from entering the lamp assembly)?
-
16. Any debris on floors (paper, cardboard, plastic wrap or loose fruit/vegetables) which could lead to patron and/or worker slips, trips, or falls, throughout the store?
-
17. Are fire suppression sprinkler heads blocked by items?
-
18. Do any fire suppression sprinkler heads have decorations attached with tape?
-
22. Any broken or missing electrical outlet covers?
-
23. Any poor housekeeping (workspace unorganized and/or large accumulation of paper, wood, or rags); creating a potential fire hazard?
-
24. Any improper storage of hazardous chemicals (cleaners, solvents, paints or gasoline)?
-
26. Are hazardous chemical containers properly labeled (IAW GHS requirements)?
-
27. Is there any equipment or machinery stored in aisles, corridors, or hallways, creating an egress hazard?
-
28. Do floor mats lay flat on floor, free of trip hazards?
-
32. Are personnel utilizing their required safety PPE (hearing protection, cutting gloves, etc)?
-
Are eyewash stations inspected weekly?
-
34. Any other issues identified?
Closeout
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Any other issues identified?
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Additional Comments:
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Completed By:
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Verified By: